Clinical experience of transbronchoscopic laser ablation for central airway stenosis using a high-power diode laser-ten years' experience at a single institute.

Abstract

High-power diode (GaAlAs) laser systems have been used for transbronchoscopic laser ablation for central airway stenosis. Such diode laser systems show a similar clinical effect to a conventional Nd-YAG laser, but the instrument is more compact with easier handling. We use a high-power diode laser system with a non-contact probe for endobronchial ablative therapy. The present study reviewed our experience with transbronchoscopic laser ablation to explore a better clinical approach for managing central airway lesions. We retrospectively reviewed the patients who were treated for central airway lesions by transbronchial laser ablation using the non-contact-type probe from January 2005 to December 2015 at Chiba University Hospital. We investigated the cause of stenosis, number of treatments, laser setting, total amount of energy, complications, and simultaneously performed modality. Thirty-three patients underwent treatment a total of 72 times. There were 23 males, with an average age of 60.3 years old (range, 18-80 years old). The primary causes of the central airway stenosis were neoplastic disease in 22 (16 malignant tumors, 6 benign tumors) and non-neoplastic disease in 11. Among malignant tumors, there were eight tracheal cancer and five lung cancer patients as well as three patients with esophageal cancer. Among benign tumors, there were three hamartomas and one patient each with papilloma, smooth muscle tumor, and glomus tumor. The non-neoplastic causes of airway stenosis were intubation or tracheotomy in four patients, tuberculosis and granulation in two each, and trauma, burn, and surgery in one each. The numbers of treatments were 30 times (1.36 times/patient) for neoplastic diseases and 42 times (3.82 times/patient) for non-neoplastic disease. The total amount of energy was 1,936 J on average (1,674 J for neoplastic diseases and 2,098 J for non-neoplastic disease). There were no major complications related to transbronchial laser ablation therapy. Transbronchoscopic laser ablation using a diode laser system with a non-contact probe can be safely performed and is useful for endobronchial treatment of both neoplastic and non-neoplastic central airway lesions.